Role of trabeculectomy in advanced glaucoma: Whether we stand to consider it a bane or a boon today?

PURPOSE: To elucidate the role of trabeculectomy in advanced glaucoma. MATERIALS AND METHODS: Only patients with primary open-angle glaucoma were selected. All patients who had cup-disc ratio of 0.9 or a near-total cupping were given a trial of aggressive maximum medical therapy for IOP control for at least 4 weeks. Target IOP was defined as ≤ 12 mm Hg. Patients who showed progression were included in the study. A total of 10 patients were selected. Trabeculectomy was performed using limbal-based conjunctival flap. Patients were followed up for a period of 2 years for visual acuity, intraocular pressure, visual fields, slit-lamp biomicroscopy and bleb morphology. RESULTS: Mean preoperative intraocular pressure on five drugs was 21.7 ± 3.8 mm Hg (range 18-27 mm Hg) on maximum medical therapy. Mean post-operative intraocular pressure was 11 ± 1.78 mm Hg (range 9-13 mm Hg) and 11 ± 1.92 mm Hg (range 9-14 mm Hg) at 1 month and 6 months post-operatively, respectively. Post-operatively, the visual acuity remained stable in 17 patients. It dropped by 1 Snellen line in 2 patients and 2 Snellen lines in 1 patient, respectively, over a period of 6 months and later improved to 6/6P following cataract surgery. There was no defined visual field progression in any of the 20 patients. CONCLUSION: Besides being a cost-effective alternative to medical management, trabeculectomy not only provides a better IOP control but also has a high safety profile when performed by an experienced surgeon.

Comparative analysis of coaxial phacoemulsification with 2.2- and 2.8-mm clear corneal incisions.

PURPOSE: To compare the intraoperative efficiency and postoperative visual outcome of coaxial phacoemulsification using 2.2- and 2.8-mm clear corneal incision coaxial phacoemulsification. SETTING: The study was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi which is a tertiary health care centre. STUDY DESIGN: This is a prospective, randomized, comparative interventional study. MATERIALS AND METHODS: A total of 140 eyes of patients undergoing cataract surgery were enrolled according to the inclusion-exclusion criteria and randomly divided in two groups of 70 such that Group I-Patients underwent phacoemulsification through 2.8-mm clear corneal incision. Group II-Patients underwent phacoemulsification through 2.2-mm clear corneal incision.Postoperative assessment was done at 1 day, 1 and 6 weeks to note best-corrected visual acuity (BCVA), ophthalmic examination, corneal topography, central corneal thickness and corneal endothelial cell count. STATISTICS: 1. Quantitative variables were compared using Mann-Whitney test and Wilcoxon ranked-sum test. 2. Qualitative variables were compared using Fisher's exact test. p value of <0.05 was considered statistically significant. RESULTS: There is steady trend in decrease in postoperative astigmatism with time, more so in 2.8 mm group; however, differences were not found to be statistically significant. 2.2 mm group had larger increase in CCT and ECC compared to 2.8 mm group which was not statistically significant (p = 0.296). CONCLUSION: Reducing the incision size from 2.8 to 2.2 mm does not result in any significant reduction in the amount of surgically induced astigmatism. Also, both the incision sizes have similar intraoperative efficacy when compared in terms of postoperative decrease in corneal endothelial cell count and increase in central corneal thickness.

How 'eye' helped in von Hippel-Lindau syndrome.

BACKGROUND: Von Hippel-Lindau syndrome is a rare autosomal dominantly inherited multisystemic oncologic syndrome, presenting predominantly with angiomatosis in embryologically similar neurologic tissue such as retina, cerebellum and adrenals. Retinal hemangioblastomas are the hallmark ophthalmic finding. In this case report, we describe the importance of timely diagnosis, thorough systemic examination and treatment of bilaterally asymmetrical retinal hemangioblastomas in a young adult male. CASE PRESENTATION: A 31-year-old male presented with painless diminution of vision in both eyes, associated with eyestrain and headache. Multiple asymmetric retinal lesions and dilated feeder vessels were noted on ophthalmoscopic examination and confirmed by fluorescein angiography to be retinal hemangioblastomas. Comprehensive systemic examination revealed cerebellar hemangioblastomas and multiple pancreatic and renal cysts. Treatment of retinal lesions was done by combination therapy of argon laser photocoagulation and cryopexy, which lead to a good visual outcome. Subsequently, neurosurgical resection of cerebellar hemangioblastoma proved to be lifesaving for the patient. CONCLUSION: RHBs are the earliest, easiest and the most frequently detected manifestation of VHL. Identification of ocular manifestations play a pivotal role in early diagnosis and timely intervention in VHL syndrome, thereby significantly reducing associated morbidity and mortality. Therefore, an ophthalmologist's role is crucial in the management of these potentially deadly tumours.

Topical vitamin C, vitamin E, and acetylcysteine as corneal wound healing agents: A comparative study.

PURPOSE: The purpose of this study was to evaluate wound healing abilities and efficacy of topical Vitamin C, Vitamin E, and acetylcysteine for their possible clinical use. METHODS: The study was conducted on 36 eyes of 18 single-breed rabbits, Oryctolagus cuniculus, of both sexes. A 7.5 mm calibrated vacuum corneal trephine was used to induce a defect of 100 micron depth in center of both the corneas. The right eye of rabbits was selected as the control eye and the left eye as the trial eye, which received eyedrops as Group 1-10% Vitamin C eyedrops, Group 2-3% acetylcysteine eye drops, and Group 3-1% Vitamin E eye drops. Control eyes received ringer lactate. Evaluation was done for fluorescein stain positivity, epithelial defect size, and corneal haze on Day 2, Day 7, and Day 14 post induction of the epithelial defect. RESULTS: On day 14, three eyes of control group, all Vitamin C and acetylcysteine treated eyes, and four Vitamin E treated eyes were fluorescein stain negative. The mean defect area on day 14 was 0, 0, 0.13, and 1.86 mm2 in Vitamin C, Vitamin E, acetylcysteine, and control eyes, respectively. Vitamin C and Vitamin E control corneal haze better than acetylcysteine in experimentally induced corneal wounds in rabbits. CONCLUSION: The three trial drugs with different mechanism of action showed similar effect on healing of the experimentally created corneal wounds in rabbits, with comparison showing statistical insignificance.

Idiopathic Bilateral Suprachoroidal Haemorrhage: A Rare Case Presentation.

55-year-old male presented with sudden onset painful diminution of vision in both eyes. On local examination, his visual acuity was FC at 2 metres in right eye and FC at 1 m in left eye. The IOP in right eye was 46 mm Hg and 44 mm Hg in left eye. The patient was admitted and started on injection mannitol, oral syrup glycerol, and oral acetazolamide. Locally, timolol maleate and brimonidine were also started. The next day, his IOP was 17 mm Hg bilaterally but his visual acuity deteriorated to FC 1 m in right eye and hand movement in left eye with inaccurate projection of rays in both eyes. USG B-scan was performed which revealed bilateral choroidal detachment. The echotexture of fluid was suggestive of haemorrhage. As the IOP was controlled, systemic hyperosmotic/antiglaucoma agents were withdrawn in stepwise fashion over next two days. The patient was started on oral prednisolone. At 2 weeks, the visual acuity in both eyes was only perception of light, with inaccurate PR. IOP was 10 mm Hg in both eyes. USG B-scan revealed resorption of the hemorrhage, with partial resolution of the choroidal detachment. The final BCVA was 6/18 and 6/12 in right and left eye.

Spontaneous levitation of dropped nucleus on first post-operative day.

A 60-year-old male patient presenting with gradual painless progressive diminution of vision was diagnosed with nuclear sclerosis grade III (LOCS). Intra-operatively, there was a nuclear drop into the vitreous cavity. The patient was left aphakic and was deferred for further vitreoretinal procedure the next day. On first post-op day, the nucleus fragment (of roughly the same size that had dropped into the vitreous) was seen in the anterior chamber. A gentle ultrasonography B-Scan done for posterior segment evaluation was anechoic. Incision was enlarged and viscoexpression of the nucleus fragment was done followed by thorough anterior vitrectomy. Post-operatively, dilated full fundus examination showed clear vitreous cavity without any evidence of retinal tear or detachment. This was later confirmed by an anechoic ultrasonography B-Scan. After 2 weeks, three-piece foldable IOL was placed in the sulcus with posterior optic capture and the patient attained a best-corrected visual acuity of 6/9P.